Boosted Reaction on Two-Step Tuberculin Skin Test among Military Personnel in South Korea, a Setting with an Intermediate Burden of Tuberculosis and Routine Bacille Calmette-Guerin Vaccination

This study was performed to estimate the rate of boosted reaction in the two-step tuberculin skin test (TST) and to evaluate the associated factors among military personnel of South Korea, which has an intermediate burden of tuberculosis (TB) and a routine bacille Calmette-Guerin (BCG) vaccination policy. Two-step TST was performed on 264 military personnel who did not have a history of close contact to TB. Subjects with a negative reaction to the first test of or =10 mm) on the initial TST was observed in 126 (48%) of the subjects. A boosted reaction on the second TST developed in 32 (23%) of the 124 subjects with a negative initial TST. In multiple logistic regression analysis, the size of the initial TST reaction was the only factor associated with a boosted reaction on the second TST. The high rate of boosted reaction among healthy adults in South Korea suggests that two-step TST should be performed to assess the baseline TST reactivity in settings with an intermediate burden of TB and routine BCG vaccination policy, especially among subjects with an initial TST reaction that is > or =5 mm.

Management of Tuberculosis Outbreak in a Small Military Unit Following the Korean National Guideline / 결핵및호흡기질환

BACKGROUND: Korean national guidelines for examining contacts with active pulmonary tuberculosis (TB) are a tuberculin skin test (TST) and chest radiographs. The treatment of a latent TB infection as performed only in those younger than six years of age who test positive for TST. Although there is a high incidence of active TB in young Korean soldiers, the current national guidelines for controlling contacts with active TB in soldiers are insufficient. This study highlights the problems with the Korean guidelines for controlling a TB outbreak in a small military unit. MATERIAL AND METHODS: In December of 2005, there was a tuberculosis outbreak in a military unit with a total of 464 soldiers in Kyung Gi province. The chest radiographs were taken of all the soldiers, and TST were carried out on 408 candidates. RESULTS: In the first screening of the chest radiographs, two active TB patients were detected. By August of 2006, four additional cases were detected, making a total of six cases after the outbreak. All the patients showed active pulmonary TB or TB pleuritis. When the results of TST in the close contacts and non-close contacts were compared, there was a significant difference in the absolute size of the induration(9.70 +/-7.50mm vs. 6.26 +/-7.02mm, p 10mm (50.0% vs. 32.0%, p<0.001) and 15mm (33.2% vs. 20.9%, p= 0.005). CONCLUSION: Although the national guidelines for managing a TB outbreak in a military unit were followed, there were continuous instances of new active TB cases. This highlights the need for new guidelines to prevent the spread of TB.

Pulmonary Complications After Hematopoietic Stem Cell Transplantation

Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.

A case of intestinal perforation in Churg-Strauss syndrome patient / 대한내과학회지

Churg-Strauss syndrome (CSS) is a disorder characterized by systemic small-to-medium vessel vasculitis, extravascular granulomas and hypereosinophilia. Gastrointestinal manifestations can occur in 37~62% of CSS patients but intestinal perforation is very rarely demonstrated. We report a case of 34-year-old man with CSS, who presented with intestinal perforation three months after diagnosed as CSS. Emergency laparotomy was performed and jejunal ulcers with perforation were found. Partial jejunectomy was performed. Pathologic findings of the resected specimen were interpretated as mucosal ulcerations which are considered to be caused by ischemia secondary to the vasculitis and eosinophilic infiltration. Since the operation, the patient has been asymptomatic.

Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass / Journal of the Korean Cancer Association, 대한암학회지

Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected thoracic esophageal carcinoma, who achieved a pathological complete remission after neoadjuvant concurrent chemoradiotherapy, is reported. The kidney is the 4th or 5th most common visceral metastasis site of a primary esophageal carcinoma. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Renal metastases from a primary esophageal carcinoma are usually latent and its diagnosis is very unusual in a live patient. The solitary renal metastasis in this case was not accompanied by metastases to other sites. The value of a nephrectomy in solitary renal metastasis of esophageal cancer is not known due to the rarity of such cases. A nephrectomy could be justified in limited situations, such as with uncertainty of histological diagnosis, severe life-threatening hematuria, which cannot be controlled by embolization, or solitary renal metastasis with a long disease-free interval.

Four cases of transient hyperammonemic encephalopathy following continuous infusion of 5-fluorouracil / 대한내과학회지

5-Fluorouracil (5-FU) is a chemotherapeutic agent commonly used in the treatment of a variety of solid tumors. Common adverse effects of fluorouracil chemotherapy include diarrhea, mucositis and myelosuppression. However, neurologic toxicities including hyperammonemic encephalopathy are rare and not well recognized. Transient hyperammonemic encephalopathy related to continuous infusion of high-dose 5-FU has rarely been reported. We report four cases of transient hyperammonemic encephalopathy in patients receiving continuous infusion of 5-FU. The mentality of all patients was altered during or just after the infusion of 5-FU. There were no focal neurological signs, laboratory excluding hyperammonemia or radiological abnormalities. After patients received adequate hydration and repeated lactulose enema, the mental status completely recovered within one or two days, and serum ammonium level subsequently returned to normal. In conclusion, we suggest that a transient hyperammonemic encephalopathy should be considered in differential diagnosis of patients receiving continuous 5-FU infusion with altered mentality.

Three Cases of Synchronous Solid Tumor and Multiple Myeloma / Journal of the Korean Cancer Association, 대한암학회지

The association between a multiple myeloma and a secondary solid tumor is not well established. Some reports showed an increased risk of secondary solid neoplasms in multiple myeloma patients, but others have not. Three cases of the synchronous occurrence of multiple myelomas and solid tumors, namely, a small cell carcinoma of the lung, an adenocarcinoma of the colon and a squamous carcinoma of the pyriform sinus were experienced at our hospital. Therefore, herein is reported the clinical courses and treatment results. The stage of multiple myeloma was Durie-Salmon stage I in all of three cases; therefore, the solid tumors were treated as a primary target because the prognosis of early stage multiple myeloma is generally better than that of advanced solid tumor, while a smoldering or stage I myeloma do not need primary therapy until progression of the multiple myeloma. Two patients died of their solid tumors, but one patient is alive.